Disability and quality of life 20 years after traumatic brain injury

Abstract

Objectives: The study describes functional outcomes and health-related quality of life (HRQL) in patients with traumatic brain injury (TBI) 20 years postinjury.

Materials and methods: Forty-four survivors who acquired moderate and severe TBI during 1995-1996 were followed 10 and 20 years postinjury. Outcomes were Glasgow Outcome Scale Extended (GOSE), Community Integration Questionnaire (CIQ), and SF-36 questionnaire (SF-36). Multiple regressions were performed to examine the relationship between follow-up measurements, controlling for baseline demographics and injury severity.

Results: There were no significant differences in baseline age and civil status between moderate and severe TBI, but patients with severe injury had significantly lower employment rates (p = 0.05). Mean age at 20-years follow-up was 50.8 (SD 11.4) years, and 73% were males. Most patients showed good recovery (52%) or moderate disability (43%). Disability levels remained stable between and within severity groups from 10 to 20 years. Community integration including social integration improved from 10 to 20 years (p = 0.01 and p = 0.005, respectively). HRQL remained stable, except for subscales Bodily Pain and Role Emotional (p = 0.02 and p = 0.06). Depression at 10 years and females were associated with poorer mental health, while productive activity at 10 years indicated better physical and mental health at 20 years postinjury, respectively.

Conclusions: Functional limitations persist even decades after moderate and severe TBI, with poorer prognosis for females and persons who were depressed at the 10-year follow-up. Development and evaluation of targeted long-term follow-up programs and access to rehabilitation services for these groups should be highlighted. Improved community integration despite stable functional limitations draws attention to long-term adaptation to adversity and illness.

Keywords: functional outcomes; long-term follow-up; quality of life; traumatic brain injury.

Figure 1

The distribution of GOSE levels in percentages at 10‐ and 20 years post‐TBI by injury severity groups

Figure 2

Community Integration Questionnaire (CIQ) Mean scores 10 and 20 years post‐TBI by injury severity groups

Figure 3

SF‐36—Mean scores 10 and 20 years post‐TBI by injury severity groups

Figure 4

Mean SF‐36 subscale score profile; the study population (n = 42) at 20 year postinjury compared to the study population (n = 57) at 10 year postinjury and general population of Norway (n = 2,323)